2) Is such coverage available in policies
issued under the Healthy New York program?

3) What type of services may be provided by
a nurse-midwife?

Conclusions:

1) The services of a nurse midwife must be
covered by a health insurer, including a Health Maintenance Organization.

2) Such coverage is available through the
Healthy New York program.

3) The practice of midwifery is regulated
by the Education and Health Departments.

Facts:

A married couple submitted an inquiry,
advising that they are eligible for Healthy New York and desire to secure health insurance
through a Health Maintenance Organization that will provide coverage for home births which
are supervised by a midwife.

Analysis:

New York Insurance Law § 4303(c)(1)
(McKinney 2000 and 2005 Supplement), made applicable to HMOs by New York Public Health Law
§ 4406(1) (McKinney 2002) provides:

(A) Every contract issued by a corporation
subject to the provisions of this article which provides hospital service, medical expense
indemnity or both shall provide coverage for maternity care including hospital, surgical
or medical care to the same extent that hospital service, medical expense indemnity or
both are provided for illness or disease under the contract. Such maternity care coverage,
other than coverage for perinatal complications, shall include inpatient hospital coverage
for mother and for newborn for at least forty-eight hours after childbirth for any
delivery other than a caesarean section, and for at least ninety-six hours following a
caesarean section. Such coverage for maternity care shall include the services of a
midwife licensed pursuant to article one hundred forty of the education law, practicing
consistent with a written agreement pursuant to section sixty-nine hundred fifty-one of
the education law and affiliated or practicing in conjunction with a facility licensed
pursuant to article twenty-eight of the public health law, but no insurer shall be
required to pay for duplicative routine services actually provided by both a licensed
midwife and a physician.

(B) Maternity care coverage also shall
include, at minimum, parent education, assistance and training in breast or bottle
feeding, and the performance of any necessary maternal and newborn clinical assessments.

While home births are not specifically
mentioned in New York Insurance Law § 4303(c)(1), if supervision of a home birth is
within the scope of practice of a midwife, the HMO would have to provide coverage for such
services.

New York Insurance Law § 4326(d) (McKinney
2002), which establishes the requirements for Healthy New York subscriber contracts,
provides:

The contracts issued pursuant to this
section by health maintenance organizations, corporations or insurers and approved by the
superintendent shall only provide in-plan benefits, except for emergency care or where
services are not available through a plan provider. Covered services shall include only
the following: . . . (6) maternity care; . . . .

Since coverage of a midwife is included
within maternity care, New York Insurance Law § 4303(c)(1), it is covered under Healthy
New York. If an HMO does not have a midwife who assists in home births in its network, it
must allow the prospective mother to access such a midwife, so long as that provider meets
the minimum requirements of the plan, who is not in the HMOs network.

Regulation of midwifery is primarily under
the auspices of the New York State Education Department, pursuant to the New York
Education Law (McKinney 2001 and 2005 Supplement) and the regulations promulgated
thereunder. New York Education Law § 6951 (McKinney 2001) provides:

1. The practice of the profession of
midwifery is defined as the management of normal pregnancies, child birth and postpartum
care as well as primary preventive reproductive health care of essentially healthy women
as specified in the written practice agreement, and shall include newborn evaluation,
resuscitation and referral for infants. Midwifery shall be practiced in accordance with a
written agreement between the midwife and (i) a licensed physician who is board certified
as an obstetrician-gynecologist by a national certifying body or (ii) a licensed physician
who practices obstetrics and has obstetric privileges at a general hospital (licensed
under article twenty-eight of the public health law) or (iii) a hospital (licensed under
article twenty-eight of the public health law) that provides obstetrics through a licensed
physician having obstetrical privileges at such institution. The written agreement shall
provide for physician consultation, collaboration, referral and emergency medical
obstetrical coverage, and shall include written guidelines and protocols. The written
agreement shall provide guidelines for the identification of pregnancies that are not
considered normal and address the procedures to be followed. The written agreement shall
also provide a mechanism for dispute resolution and shall provide that the judgment of the
appropriate physician shall prevail as to whether the pregnancy, childbirth or postpartum
care is normal and whether the woman is essentially healthy in the event the practice
protocols do not provide otherwise.

2. A licensed midwife shall have the
authority, as necessary, and limited to the practice of midwifery, and subject to
limitations in the written agreement, to prescribe and administer drugs, immunizing
agents, diagnostic tests and devices, and to order laboratory tests, as established by the
board in accordance with the commissioner's regulations. . . .

The final determination as to whether a
home birth is appropriate resides, in accordance with New York Education Law § 6951(1),
with the affiliated physician. Questions concerning the scope of practice of midwifery
should be addressed to: